The Effects of Yoga as a Pain Management Technique in Women with Chronic Pelvic Pain

The Effects of Yoga and Meditation as a Pain Management Technique in Women with Chronic Pelvic Pain

By: Abbie Marrale, SPT

Background:

Through multiple observation opportunities with pelvic floor physical therapists, I have discussed the impact of chronic pelvic pain with many individuals who suffer with this condition. Some of the main functions that chronic pelvic pain can affect are the ability to sit for prolonged period of time and engage in sexual intercourse. Many people are able to find relief for their pain through physical therapy treatments, which often include internal manual therapy and/or biofeedback. However, pelvic floor physical therapy is generally used for a short duration and does not always address the issue of the chronic nature of this condition. Learning about alternative methods that patients can engage in would benefit the patient in being able to contribute to their own pain management and would help clinicians offer more direction to patients on their home plan.

The goal of yoga, meditation, and/or breathing techniques in this situation is to decrease stress^1-2, decrease muscle tension², specifically pelvic floor muscles, and give the individual techniques they can use anywhere. Considering my interest in pelvic floor physical therapy, the aim of this investigation was to determine if learning yoga, meditation, and/or breathing techniques is an effective tool for chronic pelvic pain reduction or pain management. Additionally, the project’s secondary aim was to further explore how yoga could be used in the physical therapy setting to promote healing, health, and wellness.

Overview:

Chronic persistent pain is the presence of pain in the pelvic girdle region for over a 6-month period.³ Up to 20% of women will suffer from pelvic pain at some point in their lives, with chronic pelvic pain accounting for 10% of all visits to the gynecologist.^3-4 Yearly direct cost of chronic pelvic pain is estimated at $2.8 billion for evaluation and management strategies.³ Due to its prevalence and cost alone, it is important to have a broad array of management techniques.

As understanding of chronic pain continues to evolve, so does the treatment for pain. Currently the theories around chronic pain suggest central sensitization, causing alterations in central nervous system processing and allowing non-painful stimuli to be perceived as pain.⁵ Since the pain is not originated from solely from physical impairments, but also in large part to changes in the central nervous system, it is important that treatment also take on a bio-social-psychological nature.

Yoga is a comprehensive system for wellbeing on all levels including the physical, mental, emotional, and spiritual.⁶ There is evidence that yoga and mindfulness based stress reduction have positive effects on pain and pain management in individuals suffering from chronic pain.^7-8

The Project:

The project began with a question posed in Evidence-Based Practice II, “In middle age females with chronic pelvic pain are relaxation techniques [yoga, meditation, breathing techniques] better than pelvic floor physical therapy alone in patient reported reduction or management of pelvic pain?” Based on my overlapping interests in pelvic floor physical therapy (Women’s and Men’s physical therapy) and yoga, I was curious to discover how yoga, breath work, and meditation could complement physical therapy treatment in women with chronic pelvic pain. This project led me to understand the existing research, limitations, and evidence that support the use of these alternative methods. It was determined that in regards to middle age women with chronic pelvic pain, research suggests that yoga and other movement-based therapies may be beneficial in reducing pain. It is not conclusive that this is a better option than physical therapy, however it has been shown that yoga may significantly increase pain reduction. Recommendations based on this literature would suggest that physical therapists recommend yoga in conjunction with, although perhaps not in lieu of, physical therapy treatment for pain management. The final critically appraised topic (CAT) can be accessed Here.

Additional research was needed to specifically address the question, “In middle age adults with chronic pain, is meditation an effective means of reported pain management or pain reduction?” A similar CAT was created for this topic, and concluded that the ultimate goal of mindfulness based stress reduction therapy, or meditation, should not be primarily focused on pain reduction, but on cultivating a better relationship with the pain. It should also be noted that while meditation may be an effective strategy for pain management, it is not a replacement for standard treatment. The final CAT can be accessed Here.

Based on the evidence, a PowerPoint Presentation was created and will be given to the Triangle Pelvic Health Group, a group of physical therapists, occupational therapists, and other providers who treat pelvic floor conditions. An additional Yoga Posture Handout was created that will be provided to those in attendance, which reviews common poses, their benefits, and how to cue each posture. For added benefit, an example of a guided imagery meditation for pain relief can be accessed Here (YouTube version is available Here).

Evaluation:

I have created a brief Survey that will be given to those who attend my presentation. This survey will encompass feedback regarding both the PowerPoint presentation and the yoga posture handout that I will be providing.

Self-Assessment:

This project was the combination of two passions merged into one thought and focus. However, completing this project has been a journey that called upon a variety of different resources, professionals, and ideas I never would have foreseen. Perusing through the literature and finding out how much research was looking at the usefulness of yoga and meditation was one of my favorite parts. However parsing out the best research and the most relevant, while leaving many articles unmentioned, was nothing short of heartbreaking. I would have loved to incorporate it all into this project.

On top of synthesizing the findings, being able to transform the literature into useful, tangible material that could be used for either physical therapy or yoga practice was very exciting. There was so much more I wanted to do with this project, but as we are learning, these projects take time, focus, and a lot of work. For now I am pleased with all the information I was able to put together. However, I hope this is just the start of a long love affair with yoga and pelvic floor physical therapy.

Acknowledgements:

I would like to say a special thanks to my committee members Jennifer Harrington and Lauren Sacks for their ongoing support, feedback, and assistance along the way. I am additionally grateful for the ongoing support of my capstone advisor, Karen McCulloch. It has been such a pleasure to work with this interdisciplinary team to synthesize the information between two similar, yet different professions. I also want to thank YOU for checking this page out! Please feel free to comment or contact me at abbie_marrale@med.unc.edu with any additional questions.

References:

1. Nosaka M, Okamura H. A single session of an integrated yoga program as a stress management tool for school employees: comparison of daily practice and nondaily practice of a yoga therapy program. J Altern Complement Med. 2015.21(7):444-9.
2. Hassed C. Mind-Body therapies – use in chronic pain management. Aust Fam Physician. 2013.42(3).112-7.
3. Apte G, Nelson P, Brismee JM, et al. Chronic Femail Pelvic Pain – Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region. Pain Practice. 2011;12(2):88-110.
4. Gyang et al. Musculoskeletal causes of chronic pelvic pain: what every gynaecologist should know. Am College Obstet Gynecol. 2013;121:645-50.
5. Nijs J, van Wilgen CP, Van Oosterwijck J, Van Ittersum M, Meeus M. How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: practice guidelines. Manual Therapy. 2011;16:413-418.
6. Yoga Alliance. What is Yoga? Updated: 2016 Available at: https://www.yogaalliance.org/Learn/About_Yoga/What_is_yoga. Accessed: April 11, 2016.
7. Lee C, Crawford C, Hickey A. Mind-body therapies for the self-management of chronic pain symptoms. Pain Medicine. 2014;15:S21-S39.
8. Ward L, Stebbings S, Cherkin D, Baxter GD. Yoga for functional ability, pain, and psychological outcomes in musculoskeletal conditions: A systematic review and meta-analysis. Musculoskelet Care. 2013;11:203-217